Pre-Cert Specialist

ORTHOLONESTAR • Houston, TX

12d • $20 - $24 • Onsite

About The Position

The Precertification Specialist is responsible for patient insurance benefits including verification and authorizations. Verifies and analyzes insurance coverage plan for patients upon referral/admission. Communicates plan information to appropriate parties. Provide accurate and complete data input for precertification requests, and ongoing authorizations.

Requirements

• Working knowledge of insurances for authorization and appeals requirements
• Knowledge of Microsoft Office applications which may include Outlook, Word, and Excel
• Excellent customer service and professionalism to resolve complex payer coverage issues
• Good knowledge of general office practices and procedures
• Excellent organizational and analytical skills
• Excellent oral and written communication skills, strong interpersonal skills, and ability to work in an autonomous and independent manner
• Knowledge of HIPAA requirements
• High school diploma
• Prior experience with billing processes, prior authorizations, billing systems, knowledge of different insurance plans and ability to research complex issues

Responsibilities

• Analyzes and verifies patient insurance coverage and determines payer priority for all potential insurance and private pay coverage
• Obtains prior insurance authorization
• Reviews requests made by physicians and other authorized medical staff for additional authorized units under established guidelines
• Initiates prior and post authorization requests via fax transmission, online submission and/or telephone contact
• Returns calls back to insurance providers with precertification numbers as needed and file completed precertification requests as per established protocols
• Ensures that all prior authorizations and ongoing authorizations documentation, databases and records are maintained clearly, accurately within a timely manner, and meets HIPAA requirements

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees